One thing Raj and I agreed on from the beginning: no IVF. If we were unable to get pregnant on our own, we'd adopt. It was something we both wanted to do anyway, preferably for our second child after having our first, so if we had to move it up, it wouldn't be that big of a deal.
A year and a half into trying and failing to get pregnant, we started the process. We planned to adopt from India. It had gotten more challenging for foreigners to adopt since, fortunately, adoption had been growing in popularity within the country. First priority goes to Indian citizens in India, then Indian citizens abroad (Non-Resident Indians, or NRI), then to holders of Overseas Citizen of India (OCI) status. That title is a little bit misleading in that a person does not have to be a current citizen of India to qualify for OCI status. If you've ever been a citizen or have a parent or grandparent who has been a citizen of India, you qualify. Foreigners outside these categories can only apply to adopt older children and/or children with serious medical issues like HIV or Down Syndrome. Based on my research, many, if not most, American adoption agencies do not work with couples wanting to adopt from India who do not have NRI or OCI status. Fortunately, Raj qualified since his dad had been an Indian citizen. We chose an agency and began the paperwork, starting with collecting our many, many addresses (Raj's through carefully kept records, mine through tax returns and one "What was the address of that apartment we lived in?" email to a former roommate) so we could do the paperwork to be cleared through the child abuse registry in every state we'd ever lived in. We found a social worker who lives in Malaysia, but travels to Okinawa regularly to do home studies for couples here. We scheduled the home study for when she was already coming so we could split the cost of her travel with other families she'd be visiting. Raj went on an exercise and I went back to the States to visit, carrying with me all of the paperwork that would need to go to an Indian consulate for the OCI application. When I called there with one small question before submitting everything, it came up somehow that Raj is in the military. Foreign military members are not eligible for OCI status. (I assume this is because the status confers a permanent visa for the holder.) We couldn't get the OCI. No OCI, no adoption from India. We canceled the home study.
I talked with a friend who had done domestic infant adoption in Texas. The further we'd gotten into the adoption process from India, the sadder I became about the idea of never having a baby. As far as I remember now, about the youngest we could expect from India would be an 18 month-old, but more likely he or she would be at least two years old. So domestic infant adoption sounded like it could be a good alternative. Raj and I talked it over when we were both back in Okinawa. While we were both interested in pursuing it, we realized that doing so from Okinawa was far from ideal. The process can move quite quickly. The friend I'd talked to had gotten a call that a birth mother had chosen them while said mother was in labor. They were able to rush to the hospital and take their daughter home with them a couple of days later. For us, such a scenario would involve thousands of dollars on last minute flights, the possibility that Raj wouldn't be able to get off work come along, and then if all went according to plan, me stuck in the States with the baby while I waited for a passport and whatever other paperwork would be required to leave the country with a baby who wouldn't yet be considered permanently ours, then at least one more flight back around the world to finalize the adoption. Worse, of course, the possibility that we/I would have flown 20 hours for a false alarm, a birth mother who changed her mind. The process can also move slowly, which would mean paying for and going through a home study here only to have to start all over with a new one when we got to the States. So we decided to wait on domestic infant adoption until we were living in the US again.
That meant over a year of no movement on adoption. I'd started being seen at the hospital on base for infertility eight months prior. They offer very limited fertility resources and it's challenging to get appointments since OB/GYN here is understaffed and the many, MANY pregnant women on island have priority. It was usually at least a month between appointments plus lag time for lab results and then another long wait to schedule whatever was next. My prolactin was slightly elevated, so I had an MRI of my brain to check for a prolactinoma. I also had a hysterosalpingogram (HSG) which checks for blockages of the tubes. Both tests came back normal, which sounds like good news, except it meant there were still no answers about why I couldn't get pregnant, no identified problem to be solved. Nine months after my first appointment, I was finally prescribed Clomid, which we hoped would be our answer. Five unsuccessful cycles later, all we knew was that my progesterone levels were still below normal, even with the Clomid. We'd reached the end of what the base hospital offered. Anything further would require us to go to an off base fertility clinic.
I'd joined a Facebook group for women dealing with infertility in Okinawa and knew there was at the time only one clinic seeing Americans. They seemed, based on what the women in the group were posting, to have a high success rate. After returning from our trip to the States last June, we went for our first visit. We thought we'd just be filling out paperwork and getting into the system since they say to go on cycle days 1-3 and I was already closer to day 9. I had bloodwork, we saw the doctor for a couple of minutes, were told to go next door, and I had my first of many ultrasounds. I was about to ovulate, so we scheduled our first IUI (intrauterine insemination) for the following morning. July 4. A week later, I flew home to see my dad again just before he died. The IUI didn't work and we missed the next cycle while I stayed in Texas for a month. We did a second IUI after I got back that was also unsuccessful. Even with the Clomid, I was only producing one follicle, which gave us very little chance of success. Either we moved on to IVF or we stopped.
We had eight months left before leaving Okinawa and knew the adoption process would take at least a year, if not two or more, from the time we got started. We were coming up on two years of trying to get pregnant. We agreed to the IVF.
The next cycle, my hormones weren't good enough to try, so we waited another four weeks. The day before we left for a long weekend in Taiwan, I went for bloodwork. The translator called back that afternoon - my hormones were good enough and I could come and get my first injection and pick up the rest if I could get back there in time before they closed. I picked everything up, along with a note of explanation from my doctor, in case airport security gave us a hard time about the syringes, and we started ten days of Raj giving me a shot every morning. We were told to do them in my arms, just below the shoulder, and they became more painful each day as my arms got more sore. Still, I was grateful that Raj was willing and able to do them so I didn't have to go to the clinic every day or do them myself. I went back for an ultrasound, where we got the dispiriting news that despite the hyper stimulation of my ovaries, the ultrasound showed only two follicles. At most we could expect to have two eggs retrieved. The doctor suggested we proceed anyway since he didn't believe I'd produce more if we tried again the next cycle. We scheduled the retrieval and left with more shots to keep me from ovulating in the mean time, giving my two follicles a chance to grow bigger.
I was nervous going into the retrieval, partly because I didn't know what to expect from the procedure itself, but mostly because there seemed a good chance that we might not end up with any eggs. If we did, there was a still a good chance that we might not end up with any successfully fertilized embryos. Then we'd have to start all over. After I came out of the anesthesia, we met with the doctor. It turned out that four additional follicles had been hidden from the ultrasound and he was able to retrieve all six eggs. It was our first piece of good news in two years. We'd wait a long two days to find out how many, if any, of the eggs fertilized. Four did. The next day, we transferred two. Then we waited.
Raj convinced me to wait for blood test day, rather than testing at home. So ten days after the transfer, he met me at the clinic and we nervously waited to be called. The doctor, looking at my chart on his desk instead of at us, said something about looking like I'd just implanted. We looked over at Janie, the translator, who said, "It's positive!"
We were happy, of course. OF COURSE. But it wasn't the movie moment (or even YouTube moment) of happy tears, huge smiles, hugs and kisses. We were cautiously happy. It worked. I was finally, finally pregnant. But I was also 38 and pregnant through IVF, both of which translate to elevated risk of miscarriage. Here we were, pregnant and still trying not to get our hopes up. We told very, very few people and asked them not to tell anyone else. It was early November.
Ten days later, we had an ultrasound and saw one yolk sac. Ten days after that, another ultrasound showed a speck of an embryo with a heartbeat. We took the ultrasound pictures off the fridge before hosting Thanksgiving. Our final appointment at the fertility clinic was early in December. I took homemade cookies for the staff in a Christmas tin, along with a thank you note that I kept separate at first, just in case the ultrasound went bad and the cookies ended up being a Christmas gift instead of a Thank You for Getting Us Knocked Up gift. But again, the ultrasound looked good and no other shoe dropped.
At our first appointment on base, when I was just short of 10 weeks, we had another good ultrasound (though our squirmy baby much more closely resembled a seal than a human) and we heard a strong heartbeat at my 15 week appointment. (I cannot confirm or deny whether fear of missed miscarriage led me ask Raj to give me an after hours ultrasound at the clinic where he works in between these appointments.)
My anatomy scan was scheduled for 18 weeks. I got to see the maternal fetal medicine specialist for it, due to my age. This was the appointment we'd really been waiting for. While in Pensacola, we lived with another couple who found out at their anatomy scan that what had appeared up to that point to be a healthy pregnancy would very likely, and eventually did, end in stillbirth. Having lived through that experience with them gave us front row seats to the worst case scenario. Such was my nervous energy that I accidentally arrived at the hospital 30 minutes early.
The doctor walked us through the results of the quad screen blood tests I'd already done, which showed very low risk of chromosomal abnormalities. The ultrasound revealed that our baby was probably a girl, though she couldn't say for sure and everything looked good...except for a cyst on our baby's brain. These do happen in healthy babies and go away on their own, but are considered a soft marker for Trisomy 18. The quad screen had estimated a risk of 1/10,000 for Trisomy 18 and the ultrasound didn't show any other markers, but still. It wasn't the unqualified "Looks good!" we'd been hoping for. I went the next day for yet another blood draw (I honestly couldn't begin to give you an estimate of how many blood samples I've given in the past two years - thank goodness I'm not afraid of needles). They'd isolate the baby's DNA from my blood and could tell us with 99% accuracy whether she had any chromosomal disorders. Also whether she was actually a she.
Three weeks later, we got the all clear results. That's when, at 22 weeks pregnant, we finally announced here and on Facebook. I think it's also when we both finally let out the last bit of breath we'd been holding all this time. I'm at 25 weeks now, past the point at which our girl could potentially survive on the outside, though we of course hope she decides to stay put for another good long while.
April 24-30 will be National Infertility Awareness Week and I feel like sharing our story is one small contribution I can make to helping people who haven't dealt with infertility understand the struggle and helping those who know infertility all too well feel a little bit less alone.